Provider Demographics
NPI:1366703803
Name:BARTAK, SHAYLA (OTR/L)
Entity type:Individual
Prefix:
First Name:SHAYLA
Middle Name:
Last Name:BARTAK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6250 CORNFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-4613
Mailing Address - Country:US
Mailing Address - Phone:402-340-5262
Mailing Address - Fax:
Practice Address - Street 1:20800 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-5108
Practice Address - Country:US
Practice Address - Phone:402-340-5262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1583225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty